(134 days)
Single-Use Digital Flexible Ureteroscope (F-URS)(ZSR-URS-02, ZSR-URS-02, ZSR-URS-03, ZSR-URS-04) : This product is used in medical institutions, in conjunction with our electronic endoscope image processor. for imaging in examination, diagnosis or treatment of urinary system diseases.
Endoscope Imaging Processor (ZSR-EOS10) : Applicable to medical institutions, which are connected with electronic endoscopic diagnosis and/or treatment/surgery, and effectively display images of the field of view areas of human body cavities observed by endoscopes on monitors.
Single-Use Digital Flexible Ureteroscope (F-URS) (ZSR-URS-01, ZSR-URS-02, ZSR-URS-03, ZSR-URS-04) Single-Use Digital Flexible Ureteroscope (F-URS) is used in medical institutions, in conjunction with our electronic endoscope image processor, for imaging in examination, diagnosis or treatment of urinary system diseases. This device uses ethylene oxide (EO) sterilization process. This product consists of two main parts: an operating handle with directional control and connecting wires, as well as a flexible insertion tube.
Electronic Endoscope Imaging Processor (ZSR-EOS10) Applicable to medical institutions, which are connected with electronic endoscopes during endoscopic diagnosis and/or treatment/surgery, and effectively display images of the field of view areas of human body cavities observed by endoscopes on monitors. The device is composed of aluminum alloy chassis and motherboard and power supply components.
The Single-Use Digital Flexible Ureteroscope (F-URS) (ZSR-URS-01, ZSR-URS-02, ZSR-URS-03, ZSR-URS-04) and Electronic Endoscope Imaging Processor make up the video ureteroscope system.
The provided text is for a 510(k) premarket notification for a Single-Use Digital Flexible Ureteroscope (F-URS) and an Electronic Endoscope Imaging Processor. This type of submission focuses on demonstrating substantial equivalence to a predicate device, rather than proving novel clinical effectiveness through extensive clinical trials. Therefore, the information regarding acceptance criteria and performance studies will differ significantly from what would be found in a submission for a new AI/software device that requires proving clinical benefit.
Based on the provided text, here's an analysis of the acceptance criteria and supporting studies:
1. Table of Acceptance Criteria and Reported Device Performance
The FDA clearance for this device is based on substantial equivalence to existing predicate devices, not on specific performance metrics established as acceptance criteria for clinical efficacy. The "acceptance criteria" here refer to meeting recognized standards for medical devices of this type, ensuring safety, and demonstrating that any differences from the predicate do not raise new questions of safety or effectiveness.
| Performance Characteristic | Acceptance Criteria (Standard Reference) | Reported Device Performance (Compliance) | Notes from Document |
|---|---|---|---|
| Performance Testing | ISO 16926-6:2014 | Conforms | Endoscope Image Quality |
| ISO 8600-5:2020 | Conforms | Endoscope Image Quality | |
| IEC 62471:2006 | Conforms | Photobiological Safety | |
| ISO 8600-1:2015 | Conforms | Endoscope General Requirements | |
| ISO 8600-4:2014 | Conforms | Endoscope Test Methods | |
| ISO 12233:2017 | Conforms | Digital Image Still Camera Resolution | |
| ISO 15739:2017 | Conforms | Digital Still Camera Noise | |
| ISO/CIE 11664-4 | Conforms | Color Performance | |
| Wang, et al. (2016) | Conforms | Local Magnification Method for Geometric Distortion | |
| Wang et al. (2017) | Conforms | Field of View Measurement | |
| Wei-Chung Cheng (2023) | Conforms | Color Performance Analyzer | |
| Biocompatibility | FDA Guidance "Use of International Standard ISO 10993-1" | Conforms | Cytotoxicity, Sensitization, Irritation, Acute Systemic, Pyrogenicity |
| Sterility & Shelf-life | ISO 11135:2014 | Conforms | Ethylene Oxide Sterilization |
| ISO 11737-1:2018 | Conforms | Sterilization of Healthcare Products - Microbiological Methods - Part 1: Determination of a Population of Microorganisms on Products | |
| ISO 11737-2:2019 | Conforms | Sterilization of Healthcare Products - Microbiological Methods - Part 2: Tests on Sterility Assessed Through Microorganism Detection | |
| ISO 10993-7:2008 | Conforms | Ethylene Oxide Sterilization Residuals | |
| ASTM F1980-2016 | Conforms | Accelerated Aging | |
| ASTM F88/F88M-15 | Conforms | Seal Strength | |
| ASTM D4169-23e1 | Conforms | Performance Testing of Shipping Containers and Systems |
Discussion of Differences (from Comparison Table, if differences existed):
The document states for "Maximum insertion portion width(mm)" and "Field of view (degree)" that these are "Similar" or "Same" after analysis, concluding that "Only differences in specifications and dimensions. All the performance was tested and the results met the standard requirements, this difference will not raise any issues in safety and effectiveness." This indicates that any numerical differences in these parameters were evaluated against the relevant standards and found to be acceptable.
2. Sample size used for the test set and the data provenance
The document explicitly states: "No clinical study is included in this submission."
Therefore, there is no "test set" in the context of clinical data. The testing performed was non-clinical bench testing to demonstrate compliance with recognized industry standards and evaluate engineering performance, biocompatibility, and sterilization effectiveness.
- Sample Size for Bench Testing: The document does not specify the exact number of units or samples used for each non-clinical test (e.g., how many ureteroscopes were tested for bending angle, how many samples for biocompatibility). This level of detail is typically found in the full test reports, not the 510(k) summary.
- Data Provenance: The data provenance is from non-clinical laboratory and bench testing, likely conducted by the manufacturer or accredited testing facilities. There is no mention of country of origin for this testing, but it can be inferred the testing supports a device manufactured by Dongguan ZSR Biomedical technology Company Limited in the PEOPLE'S REPUBLIC OF CHINA.
3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts
Not applicable. As no clinical study was conducted, there was no clinical "test set" requiring expert ground truth establishment. The "ground truth" for the non-clinical tests is defined by the objective metrics and thresholds established in the referenced international standards (e.g., ISO, IEC, ASTM).
4. Adjudication method for the test set
Not applicable. There was no clinical test set requiring an adjudication method.
5. If a multi reader multi case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance
Not applicable. This device is a physical medical instrument (ureteroscope and imaging processor), not an AI/software device. No MRMC study was conducted.
6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done
Not applicable. This device is a physical medical instrument, not a standalone algorithm.
7. The type of ground truth used
The "ground truth" for this 510(k) submission is derived from:
- International Standards and Recognized Test Methods: For performance, biocompatibility, and sterility, the ground truth is compliance with the specifications and thresholds defined in the referenced standards (e.g., ISO, IEC, ASTM).
- Predicate Device Characteristics: For determining substantial equivalence, the technological characteristics and performance of the legally marketed predicate device (K230200) serve as a baseline for comparison.
8. The sample size for the training set
Not applicable. This device is a physical medical instrument, and no machine learning algorithm development (which would require a training set) is mentioned or implied.
9. How the ground truth for the training set was established
Not applicable. There was no training set.
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Image /page/0/Picture/0 description: The image contains the logo of the U.S. Food and Drug Administration (FDA). On the left is the Department of Health & Human Services logo. To the right of that is the FDA logo in blue. Underneath the FDA logo is the word "ADMINISTRATION" also in blue.
February 11, 2025
Dongguan ZSR Biomedical technology Company Limited % Kang Kyra Director Landlink Healthcare Technology (Shanghai) Co., Ltd Room 1308, Baohua International Plaza, West Guangzhong Road 555, Jingan District Shanghai, 200072 CHINA
Re: K243155
Trade/Device Name: Single-Use Digital Flexible Ureteroscope (F-URS) (ZSR-URS-01, ZSR-URS-02, ZSR-URS-03, ZSR-URS-04) Regulation Number: 21 CFR 876.1500 Regulation Name: Endoscope and accessories Regulatory Class: II Product Code: FGB Received: January 3, 2025
Dear Kang Kyra:
We have reviewed your section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (the Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database available at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.
If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.
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Page
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Additional information about changes that may require a new premarket notification are provided in the FDA guidance documents entitled "Deciding When to Submit a 510(k) for a Change to an Existing Device" (https://www.fda.gov/media/99812/download) and "Deciding When to Submit a 510(k) for a Software Change to an Existing Device" (https://www.fda.gov/media/99785/download).
Your device is also subject to, among other requirements, the Quality System (QS) regulation (21 CFR Part 820), which includes, but is not limited to, 21 CFR 820.30. Design controls; 21 CFR 820.90. Nonconforming product; and 21 CFR 820.100, Corrective and preventive action. Please note that regardless of whether a change requires premarket review, the QS regulation requires device manufacturers to review and approve changes to device design and production (21 CFR 820.30 and 21 CFR 820.70) and document changes and approvals in the device master record (21 CFR 820.181).
Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); medical device reporting of medical device-related adverse events) (21 CFR Part 803) for devices or postmarketing safety reporting (21 CFR Part 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR Part 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR Parts 1000-1050.
All medical devices, including Class I and unclassified devices and combination product device constituent parts are required to be in compliance with the final Unique Device Identification System rule ("UDI Rule"). The UDI Rule requires, among other things, that a device bear a unique device identifier (UDI) on its label and package (21 CFR 801.20(a)) unless an exception or alternative applies (21 CFR 801.20(b)) and that the dates on the device label be formatted in accordance with 21 CFR 801.18. The UDI Rule (21 CFR 830.300(a) and 830.320(b)) also requires that certain information be submitted to the Global Unique Device Identification Database (GUDID) (21 CFR Part 830 Subpart E). For additional information on these requirements, please see the UDI System webpage at https://www.fda.gov/medical-device-advicecomprehensive-regulatory-assistance/unique-device-identification-system-udi-system.
Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.
For comprehensive regulatory information about mediation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). Additionally, you may contact the
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Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).
Sincerely,
Mark J. Antonino -S
Mark J. Antonino, M.S. Assistant Director DHT3B: Division of Reproductive, Gynecology and Urology Devices OHT3: Office of GastroRenal, ObGyn, General Hospital and Urology Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health
Enclosure
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Indications for Use
510(k) Number (if known) K243155
Device Name
Single-Use Digital Flexible Ureteroscope(F-URS)(ZSR-URS-01, ZSR-URS-02, ZSR-URS-03, ZSR-URS-04) Electronic Endoscope Imaging Processor(ZSR-EOS10)
Indications for Use (Describe)
Single-Use Digital Flexible Ureteroscope (F-URS)(ZSR-URS-02, ZSR-URS-02, ZSR-URS-03, ZSR-URS-04) : This product is used in medical institutions, in conjunction with our electronic endoscope image processor. for imaging in examination, diagnosis or treatment of urinary system diseases.
Endoscope Imaging Processor (ZSR-EOS10) :
Applicable to medical institutions, which are connected with electronic endoscopic diagnosis and/or treatment/surgery, and effectively display images of the field of view areas of human body cavities observed by endoscopes on monitors.
| Type of Use (Select one or both, as applicable) |
|---|
| ------------------------------------------------- |
< Prescription Use (Part 21 CFR 801 Subpart D)
Over-The-Counter Use (21 CFR 801 Subpart C)
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510(k) Summary
l. Submitter
Dongguan ZSR Biomedical technology Company Limited Unit 448, Qingfeng Road, Taihu Village, Sanzhong Village Committee, Qingxi Town, 523651 Dongguan City, Guangdong Province,PEOPLE'S REPUBLIC OF CHINA Contact person: Mrs. Sharon Wen Position: Management Representative Tel.:+86-13728363586 E-mail: Sharon@zsrbiomedical.com
Preparation date: January 30, 2025
Submission Correspondent Ms. Kyra Kang Landlink Healthcare Technology (Shanghai) Co., Ltd. E-mail: kyra.kang@landlink-health.com
II. Proposed Device
| Device Trade Name: | Single-Use Digital Flexible Ureteroscope (F-URS: ZSR-URS-01, ZSR-URS-02, ZSR-URS-03, ZSR-URS-04)Electronic Endoscope Imaging Processor (ZSR-EOS10) |
|---|---|
| Classification Name: | Endoscope and Accessories |
| Regulation Number: | 21 CFR 876.1500 |
| Regulatory Class: | Class II |
| Product code: | FGB |
| Review Panel: | Gastroenterology/Urology |
III. Predicate Devices
| 510(k) Number: | K230200 |
|---|---|
| Trade name: | Single-Use Flexible Ureteroscope |
| Common name: | Endoscope and Accessories |
| Classification: | Class II |
| Product Code: | FGB |
| Manufacturer | Hunan Vathin Medical Instrument Co., Ltd |
IV. Reference Devices
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K243155 Page 2 of 6
| 510(k) Number: | K221158 |
|---|---|
| Trade name: | Single-Use Video Flexible Ureterorenoscope System |
| Common name: | Endoscope and Accessories |
| Classification: | Class II |
| Product Code: | FGB |
| Manufacturer | Guangzhou Red Pine Medical Instrument Co., Ltd. |
V. Device description
-
Single-Use Digital Flexible Ureteroscope (F-URS) (ZSR-URS-01, ZSR-URS-02, ZSR-URS-03, ZSR-URS-04)
Single-Use Digital Flexible Ureteroscope (F-URS) is used in medical institutions, in conjunction with our electronic endoscope image processor, for imaging in examination, diagnosis or treatment of urinary system diseases. This device uses ethylene oxide (EO) sterilization process. This product consists of two main parts: an operating handle with directional control and connecting wires, as well as a flexible insertion tube.
> Electronic Endoscope Imaging Processor (ZSR-EOS10)
Applicable to medical institutions, which are connected with electronic endoscopes during endoscopic diagnosis and/or treatment/surgery, and effectively display images of the field of view areas of human body cavities observed by endoscopes on monitors. The device is composed of aluminum alloy chassis and motherboard and power supply components.
The Single-Use Digital Flexible Ureteroscope (F-URS) (ZSR-URS-01, ZSR-URS-02, ZSR-URS-03, ZSR-URS-04) and Electronic Endoscope Imaging Processor make up the video ureteroscope system.
VI. Indication for use
Single-Use Digital Flexible Ureteroscope (F-URS) (ZSR-URS-01, ZSR-URS-02, ZSR-URS-03, ZSR-URS-04): This product is used in medical institutions, in conjunction with our Electronic Endoscope Imaging Processor, for imaging in examination, diagnosis or treatment of urinary system diseases.
Electronic Endoscope Imaging Processor (ZSR-EOS10): This product is used in medical institutions, in conjunction with our Single-Use Digital Flexible Ureteroscope, for imaging in examination, diagnosis or treatment of urinary system diseases.
VII.Comparison of technological characteristics with the predicate devices
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| Characteristics | Proposed device | Predicate device(K230200) | Discussion | |
|---|---|---|---|---|
| Tradename | Single-Use Digital FlexibleUreteroscope(F-URS) (ZSR-URS-01, ZSR-URS-02, ZSR-URS-03, ZSR-URS-04)Electronic Endoscope ImagingProcessor (ZSR-EOS10) | Single-Use FlexibleUreteroscope | / | |
| ClassificationName | Ureteroscope AndAccessories, Flexible/Rigid | Ureteroscope AndAccessories, Flexible/Rigid | Same | |
| ProductCode | FGB | FGB | Same | |
| RegulationNumber | 21 CFR 876.1500 | 21 CFR 876.1500 | Same | |
| Indicationsforuse | Single-Use Digital FlexibleUreteroscope (F-URS) (ZSR-URS-01, ZSR-URS-02, ZSR-URS-03, ZSR-URS-04): Thisproduct is used in medicalinstitutions, in conjunction withour Electronic EndoscopeImaging Processor, forimaging in examination,diagnosis or treatment ofurinary system diseases.Electronic Endoscope ImagingProcessor (ZSR-EOS10): Thisproduct is used in medicalinstitutions, in conjunction withour Single-Use Digital FlexibleUreteroscope, for imaging in | The Single-use FlexibleUreteroscope isdesigned for use with VathinDisplayUnits, endotherapyaccessories and otherancillary devices for theendoscopy andendoscopic surgery withinurinary tractand kidney in adults. | Same | |
| treatment of urinary system diseases. | ||||
| Application | field | The device is for use in a hospital or qualified medical institution. | The device is for use in a hospital or qualified medical institution. | Same |
| Intended | user | The device is only to be used by skilled medical staff trained in clinical endoscopic techniques and procedures. | The device is only to be used by skilled medical staff trained in clinical endoscopic techniques and procedures. | Same |
| Patient | Adults | Adults | Same | |
| population | ||||
| Scope | type | Flexible | Flexible | Same |
| Field of | view (degree) | $120°±10°$ | $110°$ | Same |
| Direction | of view (degree) | $0°$ | $0°$ | Same |
| Bending | angle (degree) | Up 275 °/down 275 ° (tolerance -10%, upper limit not included) | Up: 285°Down: 285° | Same |
| Maximum | insertion portion width(mm) | ZSR-URS-01, ZSR-URS-02: 2.85ZSR-URS-03, ZSR-URS-04: 2.50 | US-S170, US-E170: 3.15US-S180, US-E180: 3.25 | Similar 1 |
| Minimum | insertion channel width(mm) | ZSR-URS-01, ZSR-URS-02, ZSR-URS-03, ZSR-URS-04: 1.2 | US-S170, US-E170: 1.2US-S180, US-E180: 1.4 | Same |
| Workinglength(mm) | 670mm, tolerance ± 10% | 700 | Same | |
| Digitalvideotechnology | CMOS | CMOS | Same | |
| Illuminationsource | LED | LED | Same | |
| Single-use | Yes | Yes | Same | |
| Biocompatibility | No CytotoxicityNo Irritation to SkinNo significant evidence ofsensitization | No CytotoxicityNo Irritation to SkinNo significant evidence ofsensitization | Same | |
| Sterilization | EO | EO | Same |
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Analysis 1 -
Only differences in specifications and dimensions. All the performance was tested and the results met the standard requirements, this difference will not raise any issues in safety and effectiveness.
VIII.Non-Clinical Testing
The device described in this summary was tested and demonstrated to be in conformance with the following standards:
Performance testing:
- ISO16926-6:2014 >
- ISO 8600-5:2020 V
-
IEC 62471:2006
- V ISO 8600-1:2015
-
ISO 8600-4:2014
- ISO 12233:2017 V
- ISO 15739:2017 >
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- ISO/CIE 11664-4 >
-
Wanq, et al., "Development of the local maqnification method for quantitative evaluation of endoscope geometric distortion." Journal of Biomedical Optics 21, no. 5 (2016): 056003Wang et al., "Endoscope field of view measurement." Biomedical Optics Express 8, no. 3(2017):1441-1454.
-
Wei-Chung Cheng, "Color Performance Review (CPR): A Color Performance Analyzer for Endoscopy Devices" in Journal of Imaging Science and Technology, 2023, pp1 -9, https://doi.org/10.2352/.lmagingSci.Technol.2023.67.5.050406
Biocompatibility testing
Biocompatibility of the Disposable Ureteral Guide Sheath was evaluated in accordance with the FDA quidance "Use of International Standard ISO 10993-1" The following testing was conducted:
-
Cytotoxicity
-
Sensitization
-
Irritation
-
Acute Systemic
-
Pyrogenicity
Sterility and Shelf -life
- ISO 11135:2014 V
-
ISO 11737-1:2018
- ISO11737-2:2019 >
-
ISO 10993-7: 2008
-
ASTM F1980-2016
-
ASTM F88/F88M-15
- ASTM D4169-23e1 >
IX. Clinical Testing
No clinical study is included in this submission.
X. Conclusion
The proposed device has the same indications for use and has similar design features and technological characteristics as the predicate device. Performance testing data demonstrates that the proposed device is as safe and effective as the predicate device. Accordingly, the proposed device is substantially equivalent to the predicate device.
§ 876.1500 Endoscope and accessories.
(a)
Identification. An endoscope and accessories is a device used to provide access, illumination, and allow observation or manipulation of body cavities, hollow organs, and canals. The device consists of various rigid or flexible instruments that are inserted into body spaces and may include an optical system for conveying an image to the user's eye and their accessories may assist in gaining access or increase the versatility and augment the capabilities of the devices. Examples of devices that are within this generic type of device include cleaning accessories for endoscopes, photographic accessories for endoscopes, nonpowered anoscopes, binolcular attachments for endoscopes, pocket battery boxes, flexible or rigid choledochoscopes, colonoscopes, diagnostic cystoscopes, cystourethroscopes, enteroscopes, esophagogastroduodenoscopes, rigid esophagoscopes, fiberoptic illuminators for endoscopes, incandescent endoscope lamps, biliary pancreatoscopes, proctoscopes, resectoscopes, nephroscopes, sigmoidoscopes, ureteroscopes, urethroscopes, endomagnetic retrievers, cytology brushes for endoscopes, and lubricating jelly for transurethral surgical instruments. This section does not apply to endoscopes that have specialized uses in other medical specialty areas and that are covered by classification regulations in other parts of the device classification regulations.(b)
Classification —(1)Class II (special controls). The device, when it is an endoscope disinfectant basin, which consists solely of a container that holds disinfectant and endoscopes and accessories; an endoscopic magnetic retriever intended for single use; sterile scissors for cystoscope intended for single use; a disposable, non-powered endoscopic grasping/cutting instrument intended for single use; a diagnostic incandescent light source; a fiberoptic photographic light source; a routine fiberoptic light source; an endoscopic sponge carrier; a xenon arc endoscope light source; an endoscope transformer; an LED light source; or a gastroenterology-urology endoscopic guidewire, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 876.9.(2) Class I for the photographic accessories for endoscope, miscellaneous bulb adapter for endoscope, binocular attachment for endoscope, eyepiece attachment for prescription lens, teaching attachment, inflation bulb, measuring device for panendoscope, photographic equipment for physiologic function monitor, special lens instrument for endoscope, smoke removal tube, rechargeable battery box, pocket battery box, bite block for endoscope, and cleaning brush for endoscope. The devices subject to this paragraph (b)(2) are exempt from the premarket notification procedures in subpart E of part 807of this chapter, subject to the limitations in § 876.9.